They come from all walks of life: doctors and hairdressers, personal trainers and stay-at-home moms, law-breakers and law enforcement. They are upper class, working class, adult children of alcoholics, daughters of porn addicts, clergy, or both.   Many of them have concurrent eating disorders and/or alcohol or drug problems.  They span all ages, and while a number fit the cultural stereotype for “attractive,” many others can and do go unnoticed in a crowd.

I have been working with women who are sexually and romantically compulsive/impulsive for five years now in my role as Director of Women’s Programs at Impulse Treatment Center (ITC). ITC currently runs 11 groups a week for male Sex Addicts and four groups per week for Partners. However, having even one women’s group for Sex and Love Addicts has been difficult to establish on an ongoing basis.

A major reason that Sex Addiction was not added to the recent DSM-5 was the lack of women in treatment for Sex Addiction.   Sex Addiction in women may be relatively rare while Love and/or Relationship Addiction appears to be more common.  As noted in the proposed DSM-5 criteria, no single sexual or romantic behavior gives rise to a diagnosis of Sex and Love Addiction. To be termed “Sex and Love Addiction,” a clear destructive sexual/romantic pattern must be evidenced that disturbs relationships, careers, physical and/or emotional health.

In Ready to Heal, author and therapist Kelly McDaniel delineates the four cultural beliefs that underlie the development of Sex and Love Addiction (as known as Sex/Love/Relationship Addiction or SLRA) in women:
    I must be “good” in order to be worthy of love
    If I am sexual, I am “bad”
    I am not really a women unless someone desires me sexually and/or romantically
    I must be sexual to be loveable

The obvious impossibility of navigating these diametrically opposed beliefs is hard to miss. Throw in some childhood trauma, attachment issues, lack of boundaries or lack of modeling of healthy intimacy, and it is remarkable that more women aren’t struggling with SLRA. Or perhaps they are.

After several years of running groups for Partners of Sex Addicts I began to notice a curious phenomenon.  While most Partners evidenced the classic signs of codependence – focusing on others rather than focusing on self – many others were clearly focused on their own needs to the exclusion of all else. They felt entitled to an available partner, insisting on their fantasy version of the addict as sexual/romantic object of choice despite all evidence to the contrary.  It was the insistence on the fantasy that got me curious.  Was it possible that a number of women  in my Partners of Sex Addicts groups were also Sex/Love/Relationship addicted themselves?

I’ve never been big on labels and use the various terms primarily as a guide to treatment, so my first thought was to deal with the women together on a continuum, treating the lack of worthiness that both the Partners and the Addicts bring to their self-in-relation.  This lack of worthiness comes from many different sources; for some Partners it may result from living in too close proximity to addiction for too many years, while in other Partners or the Addicts it may go back a lot farther, all the way to childhood. And there can be distinctly different ways of acting out these issues (which gave pause to my idea of treating them together in a group).

Both nature, nurture, and the current sexualized cultural climate contribute to women’s addiction and codependency patterns. Neither role ultimately satisfies the need for self-esteem and empowerment which accounts for the cyclical shift from addiction back to codependency back to addiction. (Kasl, 1989).
 
According to the Society for Advancement of Sexual Health (SASH), sexually addictive behavior patterns in women may include: Prostitution, excessive flirting, dancing, or personal grooming to be seductive; wearing provocative clothing whenever possible; changing one’s appearance via excessive dieting, excessive exercise, and/or reconstructive surgery to be seductive; exposing oneself in a window or car; making sexual advances to younger siblings, clients, or others in subordinate power positions; seeking sexual partners in high-risk locations; multiple extramarital affairs; disregard of appropriate sexual boundaries, e.g. considering a married person, one’s boss, or one’s personal physician as appropriate objects of romantic involvement; trading sex for drugs, help, affection, money, social access, or power; having sex with someone they just met at a party, bar or on the internet (forms of anonymous sex); compulsive masturbation; and exchanging sex for pain or pain for sex.

Again, it is important to note that no one sexual/romantic behavior qualifies for a diagnosis of Sex Addiction;  diagnosis is not about judging anyone's sexual expression or behavior, but rather an evaluation of an overall pattern and history of behavior that results in legal, financial, medical, emotional and/or relational consequences.

Women who seek treatment for Sex and Love Addiction (including sexual anorexia, the other end of the acting-out continuum) usually do so because of some crisis; either confrontation or fear of confrontation by family or friends, or the legal, financial, medical, emotional and/or relational  consequences themselves.  The ageing process itself can also present a window for change.

There are a lot of challenges to working with women who have both an overwhelming longing for and fear of connection.  Early research (and the approximately 40 women we have seen at ITC to date) shows that women SLRAs have more trauma then male sex addicts.  Many women SLRAs have difficulty trusting other women; a women’s group is overwhelming just by definition.  Attachment issues in general make it difficult for women to form a safe connection with a therapist or group members.  

Initial contact by phone is extremely important.  A number of women call to talk, but can’t actually come in for treatment
because, unlike the male sex addicts, they often do not have their own money or transportation or both.  At Impulse Treatment Center, a large portion of the men we work with are still in relationship with wives/partners who are willing to support their treatment process.  Women SLRAs do not generally find the same willingness on behalf of their partners; dependency, both financial and otherwise, is a key barrier to seeking treatment.

Despite these barriers, as anyone who works with addicts of any description knows, recovery is possible. Until my work in
establishing a solid group for women SLRAs is achieved, I rely on 12-Step programs, including Sex and Love Addicts Anonymous (www.slaafws.org) and Sex Addicts Anonymous (www.sexaa.org) to provide the ongoing community so necessary to support the Addict’s vulnerable self that emerges in early sobriety. And in the meantime, I look forward to the day that a female celebrity, a la Tiger Woods, will come out of hiding and open the door to a greater cultural understanding of the truth behind Sex and Love Addiction as it impacts women.
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Charlotte Kasl, Ph.D., Women Sex and Addiction (New York: Harper and Row, 1989) 46.
Kelly McDaniel, Ready to Heal: Women Facing Love, Sex and Relationship Addiction (Gentle Path Press, 2008) 35. Society for the Advancement of Sexual Health (SASH)  www.sash.net
 
Joan Gold is a licensed Marriage & Family Therapist and the Director of Women’s Programs at Impulse Treatment Center in Walnut Creek, the oldest and largest comprehensive Sex Addiction Treatment Program in Northern California (www.sexaddicttreatment.net).  

She also has a private practice focusing on general addiction and codependency treatment as well as issues of ageing and creativity in Berkeley, CA (www.eastbayholistictherapy.com). Joan can be reached directly at 510.418.2387